Effect of integrated treatment on the use of coercive measures in first- episode schizophrenia-spectrum disorder. A randomized clinical trial Johan Øhlenschlæger a, ⁎ , Merete Nordentoft b , Anne Thorup b , Pia Jeppesen b , Lone Petersen b , Torben Ø. Christensen c , Gertrud Krarup c , Per Jørgensen c a Sct. Hans Hospital, DK-4000 Roskilde, Denmark b Bisbebjerg Hospital, Dept. Psychiatry, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark c Psychiatric Hospital Århus, Skovagervej 2, DK-8240 Risskov, Denmark Abstract The effect of integrated treatment on the use of coercive measures in first-episode schizophrenia-spectrum disorder in Denmark is not known. A total of 328 patients were randomly assigned to integrated treatment (167 patients) or standard treatment (161 patients). Integrated treatment consisted of assertive community treatment, psycho-educational multi-family groups, and social skills training. Data on coercion were extracted from the register from the National Board of Health, and data on continuity from medical records. Even though the level of continuity seemed higher in integrated treatment, this did not reduce the use of coercive measures compared to the use in standard treatment. © 2007 Elsevier Inc. All rights reserved. Keywords: Coercion; First-episode schizophrenia-spectrum disorder; Integrated treatment; Continuity 1. Introduction The quality of the first contact with the psychiatric services system is absolutely essential. It seems probable that the use of coercive measures does not help to establish a good treatment alliance but rather compromises the quality of the treatment. Sailas and Fenton (2000) conclude that there is a need for randomized trials investigating seclusion and restraint, since there are serious adverse effects and no controlled studies that evaluate the clinical value of these measures. Continuity in care has been found to have an effect on several outcomes (Adair et al., 2005; Adair et al., 2003; Brekke, Ansel, Long, Slade, & Weinstein, 1999) but it is unclear if continuity affects the level of use of coercive measures. The effect of treatment models with focus on continuity of care on the use of coercive measures in first- episode schizophrenia-spectrum disorder has not been investigated. The aim of the study was to investigate whether integrated treatment, a model containing a high degree of continuity of care, involves less use of coercive measures compared to standard treatment in first-episode schizophrenia-spectrum disorder during the first year of treatment in a randomized trial, and to compare the level of continuity in the two groups. Available online at www.sciencedirect.com International Journal of Law and Psychiatry 31 (2008) 72 – 76 ⁎ Corresponding author. E-mail address: johan.oehlenschlaeger@rh.regionh.dk (J. Øhlenschlæger). 0160-2527/$ - see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.ijlp.2007.11.003